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标准三联方案联合益生菌制剂治疗幽门螺杆菌的临床疗效

Efficacy of standard triple therapy combined with probiotics for Helicobacter pylori infection in duodenal ulcer

摘要:

目的 探讨标准三联方案联合益生菌制剂治疗十二指肠球部溃疡患者幽门螺杆菌(H.pylori)的临床疗效.方法 将225例H.pylori阳性的十二指肠球部溃疡患者随机分为3组:标准三联组(标准三联疗法)、铋剂四联组(含铋剂四联疗法)及三联联合益生菌组(标准三联联合益生菌疗法),疗程均为2周.停药4周后复查13 C尿素呼气试验及胃镜,分别观察各组溃疡的愈合率、H.pylori根除率及不良反应发生情况.结果 标准三联组、铋剂四联组及三联联合益生菌组十二指肠球部溃疡的愈合率分别为46.15%、63.49%及80.80%,三联联合益生菌组溃疡愈合率明显高于另外2组,差异有统计学意义(P值分别为0.000,0.024).H.pylori根除率比较中,按意愿(intention-to-treat,ITT)分析,三联联合益生菌组(85.33%)明显高于标准三联组(61.33%)及铋剂四联组(72.00%),差异有统计学意义(P值分别为0.001,0.046);按方案(per-protocol,PP)分析,铋剂四联组(85.71%)与三联联合益生菌组(87.67%)明显高于标准三联组(70.77%),差异有统计学意义(P值分别为0.041,0.014),但铋剂四联组与三联联合益生菌组之间差异无明显统计学意义(P=0.737).胃肠道不良反应中,便秘、味觉异常及腹胀的发生率,三联联合益生菌组明显少于另两组,差异有统计学意义(均P <0.05).结论 标准三联疗法基础上联合益生菌能提高十二指肠球部溃疡的愈合率,并能够显著降低传统根除疗法的胃肠道不良反应,提高患者依从性,从而提高H.pylori的根除率.

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abstracts:

Objective To evaluate the efficacy of standard triple therapy combined with probiotics for Helicobacter pylori (H.pylori) infection in duodenal ulcer.Methods Two hundred and twenty five patients with H.pylori-infected duodenal ulcer were randomly assigned to receive the treatment with standard triple therapy (triple group,n =75),quadruple therapy (colloidal bismuth subcitrate combined with standard triple therapy) (quadruple group,n =75) or probiotics combined with standard triple therapy (bifidobacterium and lactobacillus combined with standard triple therapy) (probiotics group,n =75) for 14 days.The gastroseopy and 13C urea breath test were performed in all patients and the adverse reactions were observed 4 weeks after treatment.Results The healing rate of duodenal ulcer in probiotics group was significantly higher than those in triple and quadruple groups (80.8% vs.46.15%,80.80% vs.63.49%;P =0.000,0.024,respectively).With intention to treat analysis,the H.pylori eradication rate in probiotics group was 85.33%,which was significantly higher than that in triple group (61.33%,P =0.001) and in quadruple group (72.00%,P =0.046).With per-protocol analysis,the H.pylori eradication rates were 85.71% in probiotics group and 87.67% in quadruple group (P =0.737),but both were higher than that in triple group(70.77%;P =0.014,0.041,respectively).The incidence of adverse reactions including constipation,taste distortion and bloating in probiotics group was significantly lower than those in the other two groups.Conclusions Bifidobacterium and lactobacillus triple live bacteria combined with standard triple therapy can increases the H.pylori eradication rate and duodenal ulcer healing rate with high compliance and low adverse reactions in patients with H.pylori-infected duodenal ulcer.

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作者: 彭卫斌 [1] 容海鹰 [1] 沙卫红 [2] 聂玉强 [3] 朱雅丽 [1] 杨元生 [1] 李锐清 [1] 张明 [1]
作者单位: 510300,广东药学院附属第二医院广州新海医院消化内科 [1] 510080,广东省人民医院消化内科 [2] 广州市消化病重点实验室, 广州医科大学附属广州市第一人民医院消化内科,510180 [3]
栏目名称: 论著
DOI: 10.3760/cma.j.issn.1671-7368.2017.02.004
发布时间: 2017-03-21
基金项目:
Medical Science and Technology Research Foundation of Guangdong Province (A2016406)广东省医学科学技术研究基金项目
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